Lesion Site in Fisher's Syndrome

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To the Editor. —In his editorial,1 Ropper commented on the article by Ryffel and myself about supranuclear eye movement disorders in Fisher's syndrome.2 He discussed the question of CNS involvement in Guillain-Barré syndrome (GBS), as though Fisher's syndrome is simply a variant. Although this assumption is widely held, as far as we know, correct evidence supporting it has never been provided. Undoubtedly, similarities between the two syndromes, such as a preceding respiratory tract or other infections and an increased CSF protein level, suggest similar pathogenetic mechanisms. These common characteristics, however, by no means necessarily allow conclusions about the anatomic site of the lesion and the structures involved. To support the argument that Fisher's syndrome is really a variant of GBS, the autopsy cases used to show absence of CNS lesions in Fisher's syndrome should at least have the disease's essential clinical features. In the cases cited by Ropper

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